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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by medtrier on December 10, 2010, at 19:58:03
Hi,
I am currently on generic Parnate, 90 mg./day. Although it helps, it doesn't do enough for my multiple health symptoms, which would be best classified as "atypical depression."
My doctor doesn't want to go above 90, esp. since the appvoved max. is 60.
I am looking for drugs that can be added to Parnate. I know it's tricky, since parnate is an MAOI, and MAOI's tend to be contraindicated with most other drugs, even Remeron. But remeron doesn't seem like it would interact badly.
So far I have tried abilify, which basically made things somewhat worse for me.
I have also been on risperidone (risperdal), and reacted badly to it. This was back when i was on lexapro.
I suppose i could try zeprexa or seroquel, but i have little desire to try antispsychotics since i am 0 for 2 on them so far, and out of the 14 drugs i have tried, they are the only ones that make me feel worse.
I was thinking about guanfacine, which is now marketed for ADHD under the new name "intuniv". It's a alpha andrenergic blocker like remeron, but doesn't mess with serotonin at all. I tried one week at 1 mg., and a week at 2 mg. of intuniv, with no luck. But that's a really low dose.
Beta blockers may be a choice as well, as anxiety is one of the problems, but not the usual type of anxiety.
I have heard on this message board that some people's doctors have mixed MAOI's with SSRI's without anything bad happening, but I doubt my doctor would go along with that.
Also, if anyone knows of psychiatrists they can recommend in the Philly-Wilmington-Lancaster-Baltimore area, that would be much appreciated. I haven't been satisfied with ANY of the ones that I have seen, and I have seen many (9 of them, including my current one).
Thanks,
Medtrier
Posted by atypical on December 11, 2010, at 6:27:30
In reply to Med's that can be combined with MAOI's, posted by medtrier on December 10, 2010, at 19:58:03
You can try Lithium or Cytomel (thyroid med) with Parnate. Some doctors will permit you to take a tricyclic such as nortriptyline with an MAOI.
Posted by Christ_empowered on December 11, 2010, at 7:21:47
In reply to Med's that can be combined with MAOI's, posted by medtrier on December 10, 2010, at 19:58:03
maybe a low dose stimulant, like ritalin or adderall?
Posted by europerep on December 11, 2010, at 9:12:40
In reply to Med's that can be combined with MAOI's, posted by medtrier on December 10, 2010, at 19:58:03
In a German psychiatric journal, an article from 2006 states that the following drugs can be given to patients on tranylcypromine:
amitriptyline, nortriptyline, reboxetine, trazodone, mianserine, mirtazapine, lithium, and some antipsychoticsMany psychiatrists will never give something like amitriptyline to someone on an MAOI, and it should really only be done in a hospital setting, but it *is* possible!
Posted by Conundrum on December 11, 2010, at 17:24:30
In reply to Med's that can be combined with MAOI's, posted by medtrier on December 10, 2010, at 19:58:03
>
> Also, if anyone knows of psychiatrists they can recommend in the Philly-Wilmington-Lancaster-Baltimore area, that would be much appreciated. I haven't been satisfied with ANY of the ones that I have seen, and I have seen many (9 of them, including my current one).
>
> Thanks,
> Medtrier
If you turn on your babble mail via settings and send me a message, I can recommend you to someone.
Posted by jedi on December 21, 2010, at 3:14:56
In reply to Re: Med's that can be combined with MAOI's, posted by europerep on December 11, 2010, at 9:12:40
Hi, I've been on a combination of nortriptyline and Nardil with no problems. Several others on the board have mixed the two. It is fairly well documented. Trazodone is widely used as a sleep aid for the MAOIs. I've also used low dose Seroquel for MAOI induced insomnia.
Be Well,
Jedi
> In a German psychiatric journal, an article from 2006 states that the following drugs can be given to patients on tranylcypromine:
> amitriptyline, nortriptyline, reboxetine, trazodone, mianserine, mirtazapine, lithium, and some antipsychotics
>
> Many psychiatrists will never give something like amitriptyline to someone on an MAOI, and it should really only be done in a hospital setting, but it *is* possible!
Posted by jpa on June 13, 2011, at 19:49:32
In reply to Med's that can be combined with MAOI's, posted by medtrier on December 10, 2010, at 19:58:03
I've been on Nardil and amitryptaline before, which proved mildly effective. However, the combination was not a long-term solution because of the sleep disturbance induced by the nardil. It completely eliminated my slow wave sleep (stage 3 and 4), something no other drug, aside from xyrem (which very few doctors will prescribe), can compensate for. Getting off Nardil nearly was the end of me, mind you I was on a high dose - 120mg. Nardil is no panacea.It's effectiveness will only last as long as you can live without recuperative sleep and it comes at a cost. Getting off it is very, very difficult. Ultimately, a combination of clomipramine, remeron and ldn proved very effective and the sleep is prestine - I feel rested and near 100 per cent better. Good luck.
Posted by jedi on June 14, 2011, at 0:21:02
In reply to Re: Med's that can be combined with MAOI's, posted by jpa on June 13, 2011, at 19:49:32
> I've been on Nardil and amitryptaline before, which proved mildly effective. However, the combination was not a long-term solution because of the sleep disturbance induced by the nardil. It completely eliminated my slow wave sleep (stage 3 and 4), something no other drug, aside from xyrem (which very few doctors will prescribe), can compensate for. Getting off Nardil nearly was the end of me, mind you I was on a high dose - 120mg. Nardil is no panacea.It's effectiveness will only last as long as you can live without recuperative sleep and it comes at a cost. Getting off it is very, very difficult. Ultimately, a combination of clomipramine, remeron and ldn proved very effective and the sleep is prestine - I feel rested and near 100 per cent better. Good luck.
Hi,
As a long term user of Nardil, over a decade, I do worry about the loss of REM sleep with the medication. Though the Nardil keeps my major atypical depression an arm's length away, I am never 100%. Even though I sleep fairly well with antihistamines and .5mg clonazepam, I know I am hurting for REM sleep. I have never been able to get off of Nardil for more than a few months without the major depression returning. I've tried so many different combinations of medications(45+). How did you come up with your cocktail?
Jedi
Posted by jpa on June 16, 2011, at 19:26:11
In reply to Re: Med's that can be combined with MAOI's » jpa, posted by jedi on June 14, 2011, at 0:21:02
> > I've been on Nardil and amitryptaline before, which proved mildly effective. However, the combination was not a long-term solution because of the sleep disturbance induced by the nardil. It completely eliminated my slow wave sleep (stage 3 and 4), something no other drug, aside from xyrem (which very few doctors will prescribe), can compensate for. Getting off Nardil nearly was the end of me, mind you I was on a high dose - 120mg. Nardil is no panacea.It's effectiveness will only last as long as you can live without recuperative sleep and it comes at a cost. Getting off it is very, very difficult. Ultimately, a combination of clomipramine, remeron and ldn proved very effective and the sleep is prestine - I feel rested and near 100 per cent better. Good luck.
>
> Hi,
> As a long term user of Nardil, over a decade, I do worry about the loss of REM sleep with the medication. Though the Nardil keeps my major atypical depression an arm's length away, I am never 100%. Even though I sleep fairly well with antihistamines and .5mg clonazepam, I know I am hurting for REM sleep. I have never been able to get off of Nardil for more than a few months without the major depression returning. I've tried so many different combinations of medications(45+). How did you come up with your cocktail?
> Jedi
>I tried over 40 different drug trials before I settled on clomipramine, remeron and ldn. I also take vitamin B2 and magnesium, which seems to help. It was tough slugging for over 15 years, but perseverance and a good doctor eventually paid off. I did a lot of research on my own, I left no stone unturned. I would go to each of my doctors appointments with copies of research papers and with a proposed course of action. My doctor is a specialist, but I had to educate him when it came to the more unconvential medications. Find a good doctor that will work with you and than move forward as a team. That's how I eventually found a combination of meds that worked for me. Finally, I would add the following: DO NOT SETTLE FOR A SECOND RATE LIFE. You can/will get better, don't stop looking until you find the right medications for you. Good luck, I wish you the success I eventually found.
Posted by hopefullynow on June 17, 2011, at 13:12:43
In reply to Re: Med's that can be combined with MAOI's, posted by jpa on June 16, 2011, at 19:26:11
> I tried over 40 different drug trials before I settled on clomipramine, remeron and ldn.Interesting combination, actually I was on all three drugs but never at one time.Can you please suggest me your dosages of clomi, remeron and LDN, please?
Regards !
Posted by jpa on June 17, 2011, at 19:09:28
In reply to Re: Med's that can be combined with MAOI's » jpa, posted by hopefullynow on June 17, 2011, at 13:12:43
>
> > I tried over 40 different drug trials before I settled on clomipramine, remeron and ldn.
>
> Interesting combination, actually I was on all three drugs but never at one time.Can you please suggest me your dosages of clomi, remeron and LDN, please?
>
> Regards !
>
clomipramine 50mg
remeron 30mg
ldn 3mg
Posted by jedi on June 17, 2011, at 22:08:27
In reply to Re: Med's that can be combined with MAOI's, posted by jpa on June 17, 2011, at 19:09:28
> > > I tried over 40 different drug trials before I settled on clomipramine, remeron and ldn.
> clomipramine 50mg
> remeron 30mg
> ldn 3mg
JPA,
What was your diagnosis before remission on the above cocktail?
Thanks,
Jedi
Posted by jpa on June 19, 2011, at 10:12:48
In reply to Re: Med's that can be combined with MAOI's » jpa, posted by jedi on June 17, 2011, at 22:08:27
Chronic pain and associated sleep disturbance.
Posted by Chairman_MAO on October 6, 2011, at 14:16:52
In reply to Med's that can be combined with MAOI's, posted by medtrier on December 10, 2010, at 19:58:03
http://www.ncbi.nlm.nih.gov/pubmed/2710808
Show your doctor that. The dose you want to shoot for is 1.5mg/kg/day or a max of 200mg/day.
Combining an MAOI with an SSRI is not worth the risk. And by that I mean you're much safer taking dextroamphetamine while on an MAOI than using an SSRI. It can be done, but I'm not sure if there is ever any actual benefit to speak of.
Posted by SLS on October 14, 2011, at 19:35:23
In reply to Re: Med's that can be combined with MAOI's » medtrier, posted by Chairman_MAO on October 6, 2011, at 14:16:52
> It can be done, but I'm not sure if there is ever any actual benefit to speak of.
I think that adding a SRI to a MAOI that inhibits MAO-A (including RIMAs) is a recipe for severe or fatal serotonin syndrome. Personally, I would not encourage anyone by saying that it can be done.
I once dared to tickle the dragon's tail by adding a minute dose of Effexor to Parnate. I became incoherent and could not move a muscle for at least an hour. I chose Effexor because it has such a short half-life - just in case. I was lucky.
- Scott
Posted by Chairman_MAO on October 14, 2011, at 21:40:17
In reply to Re: Med's that can be combined with MAOI's » Chairman_MAO, posted by SLS on October 14, 2011, at 19:35:23
I am not encouraging anyone. I never said to do it. In fact, I think it's a horrible idea. However, not _everyone_ that has had the combination gets serotonin syndrome. Most do.
http://www.ncbi.nlm.nih.gov/pubmed/2347858
With a RIMA, it is not completely insane, but still something that is generally contraindicated. And unlike adding a psychostimulant to an MAOI, I really don't see the rationale.
http://www.ncbi.nlm.nih.gov/pubmed/9585794
Perhaps I wasn't clear enough, but people are responsible for themselves. If I said, "some people have survived jumping from a plane without a [functioning] parachute", I can't help it if someone takes that to mean that I am encouraging it.
This is the end of the thread.
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